Method for controlling a drug dispensing system

ABSTRACT

An automated drug dispensing system includes a cabinet adapted to store a variety of prepackaged pharmaceuticals in a plurality of bins for filling patient prescriptions. Each bin stores a particular variety of packaged multiple-dose pharmaceutical. Each variety of pharmaceutical is associated with a particular code. A controller receives request signals and in response generates dispense signals. Each bin includes a dispenser coupled to the controller for dispensing the packaged pharmaceuticals therefrom in response to a dispense signal sent from the controller. After a package is dispensed, a code reader determines the code of the dispensed package and verifies whether the code on the dispensed package matches the code of the requested package.

CROSS REFERENCES TO RELATED APPLICATIONS

[0001] This application is a Continuation of U.S. application Ser. No.10/093,910, filed Mar. 7, 2002 which is a Continuation of U.S.application Ser. No. 09/945,232, filed Aug. 31, 2001 which is aContinuation of U.S. application Ser. No. 09/515,777, filed Feb. 29,2000, now U.S. Pat. No. 6,283,322, issued Sep. 4, 2001 which is aContinuation of U.S. application Ser. No. 09/058,524, filed Apr. 10,1998, now U.S. Pat. No. 6,068,156, issued May 30, 2000 which is aContinuation of PCT/US96/16758, filed Oct. 18, 1996, which is aContinuation-in-Part of U.S. application Ser. No. 08/642,484, filed May3, 1996, now U.S. Pat. No. 5,797,515, issued Aug. 25, 1998 which is aContinuation-in-Part of U.S. application Ser. No. 08/544,623, filed Oct.18, 1995, now U.S. Pat. No. 5,713,485, issued Feb. 3, 1998. The entirecontents of the above applications are incorporated herein by referencein entirety.

BACKGROUND OF THE INVENTION

[0002] Automated pharmaceutical delivery systems have been in use forover thirty years. The initial purpose of such systems was to reduce thehigh rates of medication errors associated with manual distribution. Inmodern times, automated systems present more sophisticated advantages.These include: further reduction of errors, lower costs associated withpharmaceutical distribution, reduction of personnel, inventory control,substance control, automated documentation, and relieving professionalpharmacists of many tasks.

[0003] The current state of the art of automated pharmaceutical deliverysystems, otherwise known as medication management devices generally fallunder three categories: automated devices in the central pharmacy area;automated devices in the patient care unit; and point-of-careinformation systems.

[0004] The primary goal of centrally-located devices is to replace orimprove the current manual process for filling unit dose carts. Thesedevices offer the advantage of a single, centralized inventory and alower overall inventory. Disadvantages of such devices include theirlarge size, high cost, and reliance on efficient delivery systems.

[0005] Patient care unit-based devices replace the traditional manualunit dose cart filling and delivery system and provide increased controlover floor stock. Advantages of such systems include their smaller sizeand lower cost relative to centrally-located devices, immediate accessto medications, and automated documentation of medicationadministration. Disadvantages include application to unit dose levelsonly, increased costs due to the maintenance of multiple inventories inmultiple units, additional time required to restock multiple devices,and larger inventory.

[0006] Point-of-care systems are designed to enable immediate exchangeof patient data at the bedside. Such systems allow for rapid access topatient information, fast documentation, integration of hospitalinformation systems, and immediate verification of drug administration.Primary disadvantages of point-of-care systems include high costassociated with placing hardware in each room, networking the system,and security issues associated with personal data access.

[0007] The above-described systems offer solutions for medicationmanagement in large hospitals where the large expense associated withlarge centrally-located pharmacy systems, decentralized patient careunits, and point-of-care systems at the bedside are justifiable forunit-dose dispensing and verification. These systems fail to addressefficient and economical medication management at medium sizefacilities, for example health maintenance organizations which cannotjustify the expenses associated with the large and costly aforementionedsystems. Furthermore, while the above systems provide a solution forunit-dose dispensing for individual patients, they fail to address theissue of filling weekly or monthly prescriptions in a cost-effectivemanner.

SUMMARY OF THE INVENTION

[0008] The present invention combines computer hardware and software, atelecommunications capability, and a medication container dispensingcabinet to form a complete in-office dispensing system. This enablesdrug prescription dispensing in volume by a physician, pharmacist, orother licensed practitioner directly to the patient at a clinic, grouppractice, or other location outside a pharmacy or hospital. The systemprovides a convenient, safe, automated, and low cost drug deliverysystem for the patient.

[0009] The present invention is directed to an apparatus and method forautomated dispensing of packaged pharmaceuticals. The apparatus of theinvention includes a cabinet housing for storing a variety of packagedpharmaceuticals in a plurality of bins. Each bin stores a particularvariety of packaged pharmaceutical where each package typically containsa plurality of unit doses as normally provided in a pharmacy filledprescription. Each variety of pharmaceutical is associated with aparticular code marked on the package. When the packaged items areloaded into the system, the loader scans each bar coded package with abar code reader so that the data base for the unit properly reflects thepackages contained in the unit. For dispensing, a controller receivesrequest signals and in response generates dispense signals. Each binincludes a dispenser coupled to the controller for dispensing a packagedpharmaceutical therefrom in response to a dispense signal sent from thecontroller. When the package is dispensed, a code reader determines thecode of the dispensed package and verifies whether the code of thedispensed package matches the code of the requested package.

[0010] The dispensing process can be initiated by an authorized user ata computer terminal connected to the cabinet controller. Alternatively,a computer can be used to program a card or slip with patientinformation, with the cabinet being adapted for receiving the card, forautomatic dispensing directly to the patient.

[0011] A plurality of the cabinet housings can be installed in a modularor daisy-chained configuration in which a single controller operates aplurality of housings. In a preferred embodiment of the apparatus of theinvention, the bins are in the shape of vertically-disposed columnsshaped to store a plurality of bottles stacked vertically. Each bottleis sealed and contains a selected number of doses prior to beingdispensed. Pharmaceutical packages are laid on top of each other withineach column and are fed by gravity from the top of the column and exitat the bottom of the column on a first-in-first-out basis. Each columnincludes a replaceable label containing a code which matches the codedisposed on the packages placed in that column. Package coding ispreferably accomplished by bar code which can include the drugidentification number, dosage expiration date and number of tablets. Thecontroller is preferably a computer. In an automated system, sensorsmounted in the bins monitor the inventory of the packages in each binand detect jammed bins.

[0012] The cabinet is preferably mounted on a wall or on a supportingcart as a stand alone unit. A ramp delivers a dispensed pharmaceuticalto a drop point. The ramp is preferably sloped so that gravity deliversthe dispensed pharmaceutical without the need for other conveying means.A label printer is coupled to the controller for printing a patientspecific prescription label for attaching to a dispensed pharmaceuticalpackage. The prescription label can include a printed picture of thepharmaceutical contained in the package. A document printer is likewisecoupled thereto for printing instructions specific to the dispensedpharmaceutical for use by the patient or medical practitioner. In apreferred embodiment, the printers are inhibited until the bar-codereader verifies that proper dispensing of the pharmaceutical hasoccurred.

[0013] A preferred method of using the invention for a clinical trialincludes dispensing a pharmaceutical and a placebo in different packagesand monitoring use thereof. Clinical trials are commonly used in theevaluation of the safety and effectiveness of drug protocols in thepharmaceutical industry. These trials can typically take the form ofdistributing the drug being tested and a placebo to a selected patientpopulation and then monitoring the outcome to determine the drug'seffectiveness. The dispensing system of the present invention isparticularly well suited to aid in the controlled distribution of boththe drug (or drugs) under test and the placebo used in these clinicaltrials. Due to the accurate labeling, record keeping and remotedistribution capabilities, and the ability to dedicate specific units toa particular trial the conduct of these trials can be done more safelyand accurately.

BRIEF DESCRIPTION OF THE DRAWINGS

[0014] The foregoing and other objects, features and advantages of theinvention will be apparent from the following more particulardescription of preferred embodiments of the invention, as illustrated inthe accompanying drawings in which like reference characters refer tothe same parts throughout the different views. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingthe principles of the invention.

[0015]FIG. 1 is a diagram of preferred embodiment of an automated drugdispensing system in accordance with the present invention.

[0016]FIG. 2 is a block diagram of an automated system forpharmaceutical distribution and inventory management in accordance withthe present invention.

[0017]FIG. 3 is a block diagram of a preferred embodiment of a cabinetrack in accordance with the present invention.

[0018]FIG. 4 is a block diagram of an automated drug dispensing systemhaving daisy-chained remote control dispenser cabinets in accordancewith the present invention.

[0019]FIG. 5 is a perspective view of a dual-valve dispenser inaccordance with the present invention.

[0020] FIGS. 6A-6C are sequential illustrations of the operation of thedual-valve dispenser.

[0021]FIG. 7A is a flow diagram of the main menu software.

[0022]FIGS. 7B and 7C are flow diagrams of the prescription menusoftware.

[0023]FIG. 8 is a schematic diagram illustrating the administration of aclinical trial in accordance with the invention.

[0024]FIG. 9 is a schematic diagram of a circuit board using acontroller for a drug dispensing system in accordance with the presentinvention.

[0025]FIG. 10 is front view of a dispensing system on a rollable cart inaccordance with the invention.

[0026]FIGS. 11A and 11B are block diagrams of system configurations inaccordance with the present invention.

[0027]FIG. 12 is a flow diagram representing the processes performed bythe pharmacy technician at an RCD and a registered pharmacist at an RPHin accordance with the present invention.

[0028] FIGS. 13A-13Q are flow diagrams representing the softwareoperating on the remote pharmacist (RRPH) workstations.

[0029] FIGS. 14A-14V are images of the user interface for the RPHworkstation software.

[0030]FIG. 15 is a printout of a patient monograph to be administered tothe patient along with labels for adherence to the dispensedpharmaceutical in accordance with the present invention.

[0031]FIG. 16 is a block diagram representing a variety of remote drugdispensing configurations in accordance with the present invention.

[0032]FIG. 17 is a schematic block diagram representing the transfer ofdata between an RCD host computer and a remote RPH workstation inaccordance with the present invention.

[0033]FIG. 18 is a schematic block diagram representing connectivitybetween RCD units at various sites in accordance with the presentinvention.

[0034]FIG. 19 is a schematic block diagram representing dual modemconfiguration in accordance with the present invention.

[0035]FIG. 20 is a perspective view of a roller dispenser in accordancewith the present invention.

[0036] FIGS. 21A-21C illustrate operation of the roller dispenser duringa dispensing sequence.

[0037]FIG. 22 illustrates a direct-drive roller dispenser embodiment inaccordance with the present invention.

[0038]FIGS. 23 and 23A illustrate a step column in accordance with thepresent invention.

[0039]FIG. 24 is a close-up view of an alternative embodiment of aroller dispenser face in accordance with the present invention.

[0040]FIG. 25 is a perspective illustration of a rack of columns inaccordance with the present invention.

[0041]FIG. 26 is a perspective illustration of drawers of helixdispensers.

[0042]FIGS. 27 and 28 are close-up views of a dispensing sequence forthe embodiment of FIG. 26.

[0043]FIG. 29 is a perspective illustration of a system including helixand column dispensers in accordance with the present invention.

[0044]FIG. 30 is a perspective illustration of a cabinet-styledispensing system in accordance with the present invention.

[0045]FIG. 31 is a perspective illustration of a cabinet used in thesystem of FIG. 30 in accordance with the present invention.

[0046]FIG. 32 illustrates a dispensing unit having a plurality ofworkstations in accordance with the present invention.

[0047]FIG. 33 illustrates a kiosk system in accordance with the presentinvention.

DETAILED DESCRIPTION OF THE INVENTION

[0048] The present invention provides safe pharmaceutical prescriptiondispensing directly by physicians, pharmacists, and other licensedpractitioners operating in small to medium size locations in acost-effective manner. Prepackaged pharmaceuticals are stocked at nearbymunicipal service centers and distributed to the health care locationsas needed. The inventory is continually and automatically monitored by ahost computer at the location. Inventory is ordered on a just-in-timebasis by the computer. In this manner, prepackaged multiple-dosepharmaceuticals are available to practitioners at the health-carefacility for immediate filling of patient prescriptions.

[0049] The present invention offers significant advantages to physiciangroup practices. The system improves customer service and enhances theimage of the group practice. Drug theft is prevented by securing thepharmaceuticals in a closed system and inventory is kept low. The systemmeets state pharmacy, safety, and regulatory compliance laws, whereasmany manual dispensing systems do not. A pharmaceutical distributor canhandle all inventory planning, financing, maintenance, and ordering withminimal interaction with group practitioners. Disruptive telephone callsto the physician from pharmacists are minimized. Further, physicians cangain immediate access to a patient's pharmacy records currentlyunavailable to him.

[0050] Managed care providers, for example, Health MaintenanceOrganizations and Pharmacy Benefits Managers also realize significantadvantages from the present invention. The invention increases thelikelihood that a patient will receive the required treatment, becausethe pharmacy is available at the doctor's office. Labor costs forin-house pharmacies are reduced, allowing staff reductions orreassignments. In-house drug dispensing can be extended tophysician-staffed satellite clinics and other locations not suitableeconomically for conventional pharmacies. The system enables automatedpatient compliance enhancing programs, drug utilization analysis, andthe use of other emerging pharmacy management opportunities to reducecosts and improve patient compliance and wellness. Drug costs arereduced by formulary control, thereby encouraging generic substitutionof name brand drugs. Inventory is tracked automatically by the drugdistributor headquarters, thus preserving professional time for patientcare.

[0051] The present invention also offers significant advantages to thepatients. Drugs are provided immediately at the physician's office,avoiding an inconvenient trip to a pharmacy. This is particularlyimportant to mobility-impaired patients and eliminates a major source ofdrug non-compliance. Electronic third-party payor cards can be used fordrug purchases at the doctor's office. The patient can obtainprescription drugs at prices competitive with retail discounters. Thephysicians are able to track prescription compliance which can result infaster recovery.

[0052] The apparatus of a preferred embodiment of the invention will nowbe described. FIG. 1 is a diagram of an automated drug dispensing systemin accordance with the present invention. The primary components of thesystem include a remote control dispenser (RCD) cabinet 20, a hostcomputer 46, a modem 52, a document printer 56, and a label printer 54.The cabinet 20 includes a rack 24 comprising a plurality of bins,preferably in the shape of columns 34. Packages 32 such as drug bottles,containing pharmaceuticals of various types are distributed among thecolumns 34, each column 34 containing a separate type of pharmaceutical.Four racks 24 are enclosed in the cabinet 20 chamber, two in the maincabinet 20 and two on the doors 22. The doors are secured by locks 28.

[0053] A licensed user, for example, a doctor, pharmacist, nurse, orother medical practitioner qualified to fill patient prescriptions,operates the system at the host computer 46, using a keyboard 50 andmouse 66 for input and receiving visual feedback at a monitor 48. Usingthe keyboard 50, a user enters a command to request dispensing of aparticular packaged pharmaceutical variety 32 for a particular patient.The computer 46 transmits the request via an interface 70 to acontroller 42 located on the RCD cabinet 20. The controller 42interprets the command sent from the computer 46 and enables adispensing actuator 68 in the appropriate column 34. The lowest package32 in the appropriate column 34 is released from the column 34 andejected onto a ramp 30. The released package 74 slides down the ramp 30into an opening 26, where the released package 74 is made available tothe dispensing party for transfer to the patient. A bar code reader 40,located near the dispensing opening 26, reads a code 98 on the dispensedpackage 74 and transmits the bar code information to the computer 46,which informs the user whether the code 98 on the dispensed package 74matches that which was requested by the user. The bar code 98 can bedisposed on the side, top, and/or bottom of the package 32. In anautomated embodiment of the system, sensors 36 located on each column 34monitor the dispensing process and notify the controller 42 of anypackage jams. The sensors 36 also monitor inventory of the columns 34and notify the computer 46 through controller 42 that a particularcolumn is empty or near empty.

[0054] Alternatively, the prescription can be dispensed directly to thepatient. A card reader 38, mounted directly on or near the cabinet, isadapted to receive a card 39 from a patient. The card is programmed withpatient information by a licensed practitioner. The patient inserts thecard 39 in the card reader 38 and receives his medication automaticallyfrom the cabinet. The medication bottle 32 may be filled with a singledose of medication for a particular patient, or can include weekly ormonthly doses. This embodiment is especially useful in largeinstitutions, such as prisons, where many individuals require medicationon a regular basis.

[0055] Upon validating the bar-code 98 of the dispensed package 74, thecomputer generates a label 58 containing prescription information at alabel printer 54 to be placed on the package, and generates a document60 at a document printer 56 containing additional instructions for thepatient or practitioner. A modem 52 enables periodic or continuouscommunication between the host computer 46 and other computers in thenetwork so that a complete inventory and status of each remote controldispenser cabinet is available at all times. Several remote controldispenser cabinets 20 can be integrated into a single installationoperated by a single computer 46. The cabinets 20 can each beindividually connected to the host computer 46, or may be daisy-chained,with only one cabinet 20 in the chain connected to the host 46.

[0056] A typical remote control dispenser cabinet 20 contains fortycolumns 34 for holding and dispensing the prepackaged pharmaceuticals.Each rack 24 includes ten columns 34, as shown in FIG. 3. Two racks aredisposed on each side of the cabinet, one in the main cabinet area 20,and one on the door 22, such that when the door 22 is closed, the racks24 face each other. A typical column will hold up to 13 packages of agiven pharmaceutical. The columns at the ends of the cabinet 34A areshorter than the columns nearest the center of the cabinet 34B toaccommodate the sloped ramp 30. The ramp 30 receives a dispensedpharmaceutical package, and directs it toward the dispensing area 26 inthe center of the cabinet 20. A raised ramp divider 31 divides the ramp30 into two sections 30A, 30B, each section for dispensingpharmaceutical packages from each rack.

[0057] At the top of each column 34 is a replaceable bar code label 76which identifies the pharmaceutical contained in that column and theappropriate column number. At the time of loading the cabinet, thecolumn bar code label 76 is matched against the package label 98 to beloaded to verify that the correct pharmaceutical package 32 is placed ineach column. Referring back to FIG. 1, the RCD controller 42 receivescommands from and transmits status information to the host computer 46via the controller interface 70. A request command sent from the hostcomputer 46 identifies the pharmaceutical package 32 to be dispensed. Inresponse, the RCD controller 42 activates the appropriate dispenser 68,thereby releasing a single package of the variety requested. A parallelor serial I/O interface 62 at the host computer 46 provides a sufficientcommunication channel. The simplest interface is a unidirectionalchannel from the host computer 46 to the controller 42. A full dupleximplementation allows the controller 42 to transfer status informationback to the host 46. Status information may include errors such aspackage jams, empty columns, or other cabinet status. Availability ofsuch information prevents inconsistencies in the database and providesthe operator with recovery procedures. This would require adequatesensors 36 to be mounted in appropriate positions on the RCD cabinet 20.

[0058] The bar-code reader 40 can be mounted directly on the unit or cancomprise a hand-held unit 41. It verifies proper loading of the RCDcabinet 20 and proper dispensing of each pharmaceutical package 32.Before a column 34 is loaded with packages 32, the column bar code label76 is compared with the bar code label 98 of each package 32 insertedinto the column 34. Each time a package 74 is dispensed from the cabinet20, the package bar code label 98 is scanned by the bar code reader 40to verify that the correct pharmaceutical has been dispensed. The barcode reader 40 is interfaced to the host computer 46 through a standardkeyboard wedge 64. The wedge 64 makes the bar code reader 40 input viathe bar code interface 72 appears to be coming from the keyboard 50.Such an interface is a simple and reliable interface to the pharmacysoftware operating on the computer 46. The bar code reader 40 must behighly reliable and provide a high first read rate. Label printing onthe pharmaceutical packages 32 must be of high quality to accommodatethis. During loading, the bottles are loaded into each column up to acertain height. the highest bottle in the column is positioned adjacenta bar coded column label 75 running along each column. Thus, the numberof bottles in each column can be recorded at loading and tracked duringuse.

[0059] The host computer 46 runs the pharmacy software, provides a userinterface, and supports the RCD controller 42, bar code reader 40, andmodem 52. A standard off-the-shelf personal computer and operatingsystem are sufficient to meet these requirements. As described above,the keyboard 50 and mouse 66 receive input from the user and the monitor48 provides visual feedback. The document printer 56 printsdocumentation 60 such as detailed instructions and a label printer 54prints package labels 58, for example, prescription information 59 foradherence to the dispensed package 74. The prescription label 58 mayalso include a printed picture of the pharmaceutical 57 contained on thebottle to provide additional security.

[0060] The modem 52 provides a communication link between the municipalservice center (MSC) 106 and the remote control dispenser 108. Throughthis link, inventory of each RCD cabinet 20 is automatically monitoredand updated in the MSC 106 computer. The modem link also serves as amedium to issue restock orders, update pharmacy software running on thehost computer 46, and provide remote diagnostics. The modem can becompatible with standard telephone lines and can be capable oftransferring data at sufficient rates.

[0061] The pharmacy software operating on the host computer 46 is astandard commercial software package which provides standardadministrative and accounting capabilities. The pharmacy software alsosupports the unique features of the remote control dispenser system.These include: data communication with the RCD controller 42 viaparallel or serial I/O interface 62; data communication with the barcode reader 40 via keyboard wedge 64; data communication with themunicipal service center via modem 52; printing of labels 58 with thelabel printer 54 and printing of documentation 60 with the documentprinter 56. The software is described in further detail below inconjunction with FIGS. 7A, 7B, and 7C.

[0062] The cabinet 20 and rack 24 are preferably fabricated fromaluminum, stainless steel, or plastic to be fully compatible with aclinical setting. The rack 34 can be modified to provide for a diversityof packages including various box and bottle sizes, unit-of-usepackaging, liquids, syringes, and various non-prescription products, forexample, medical supplies.

[0063] The computer 46 can comprise a portable terminal, a notebookcomputer, or a hand-held personal digital assistant. Voice recognitionor voice prompted software can be employed using a telephone or wirelesslocal area network. Voice recognition systems can use a generic or auser-customized system and can include voice signatures. The objectiveis to maximize system flexibility and ease of use for the doctor andstaff without compromising safety. The remote control dispenser systemcan be utilized as a free-standing system, as a local network integratedwith physician office computers, or as a centralized network inconjunction with product release at a remote location.

[0064]FIG. 4 is a block diagram of a remote control dispensingconfiguration having daisy-chained remote drug dispensing units 20. Acomputer 100 at distribution headquarters is connected through a modem52 to a bidirectional communication link 118. A computer 106, includingdisk storage 107 and a printer 56, at the municipal service center 106communicates with headquarters 100 and with a plurality of remotecontrol dispenser workstations 46 via modems 52. The RCD workstations 46include a printer 56 and may include personal data assistants 122. Theworkstation 46 is connected via a controller interface 70 to remotecontrol dispenser cabinets 20. The cabinets 20 can be daisy-chained asshown or may each be individually connected to the workstation 46. Thecomputer 100 can also be linked by modem to all or selected remotedispensers so that each dispenser can be remotely controlled.

[0065]FIG. 5 is a perspective view of a dual-valve dispenser 68. Asshown in FIGS. 1 and 3, each column 34 includes a dispenser unit 68. Thedispenser unit 68 is located at the bottom of each column for dispensinga single bottle 32 when commanded by the user. A preferred dispenser 68includes an upper solenoid 80A and a lower solenoid 80B. Each solenoid80A, 80B engages a corresponding dispenser valve 84A, 84B. The dispenservalves 84A, 84B are biased in a closed position by return springs 82A,82B. All dispenser components are mounted to a housing 86.

[0066] FIGS. 6A-6C illustrate operation of the dispenser valve during adispensing sequence. In FIG. 6A, a gravity-fed column of bottles 32 isheld in place by a bottle rack 24. A lower bottle 32B is retained bylower solenoid 80B and lower valve 84B and held in place between thevalve 84B and the wall of the rack 24. The remaining bottles in thecolumn 32A are retained by the upper solenoid 80A and upper valve 84A.In FIG. 6B, the lower solenoid 80B retracts, preventing the lower valve84B from interfering with the lower bottle 32B. This allows the lowerbottle 32B to be released and dispensed. The upper bottles 32A continueto be held in position by upper valve 84A.

[0067] In FIG. 6C, the lower solenoid 80B is reactivated and lower valve84B again interferes with the rack 24. The upper solenoid 80A is thenretracted, disengaging the valve 84A from the upper bottles 32A. Thisallows the column 32A to fall and the lowest bottle engages the lowervalve 84B. The upper solenoid 80A next closes the upper valve 84A,causing it to engage the next bottle 32A in the column. In this manner,a single bottle 32B is dispensed, the remaining bottles 32A all descendone position, and the dispenser 68 is again ready to dispense as shownin FIG. 6A.

[0068] An alternative dispenser, referred to herein as a “roller”dispenser, is illustrated in the perspective view of FIG. 20. Eachcolumn 606 includes a roller dispenser unit 622. Each roller has endfaces 618, 626, and a side wall 620 in the shape of a sectionedcanister. The roller is adapted to rotate about bushings 619. A motorassembly 608 at the top of each column 606 drives a cam 610. A drivecable 612 is coupled to the cam 610 at a proximal end, and a pin 614 onthe side wall 620 of the roller 622 at a distal end. As the rollerdispenser unit is activated, the motor 608 causes the cam 610 to rotate,which in turn tensions the drive cable 612. This causes the roller 622to rotate in the direction shown by arrow 623. The roller rotates nearlya half turn and causing a bottle cradled in the hollow portion 624 ofthe roller to be dispensed. After tension is removed from the drivecable 612, the return spring 616 returns the roller 622 to its originalposition.

[0069] FIGS. 21A-21C illustrate operation of the roller dispenser 622during a dispensing sequence. In FIGS. 21A, a gravity fed column ofbottles 604A-D is held in place by a bottle rack 606. The lowest bottle604A in the stack is located in the opening 624 of the roller assembly622. The remaining bottles 604B-D rest above bottle 604A.

[0070] In FIG. 21B, the motor has tensioned the drive cable 612 and tugson the cable 612 connected to pin 614 on the roller 622. This causes theroller 622 to rotate in the direction shown by arrow 625, therebydispensing bottle 604A. As the roller rotates, the leading edge 623comes in contact or “slices” the lower edge of bottle 604B, causing thecolumn of bottles above bottle 604A to raise slightly. Thecircumferential length of the roller side wall 620 (see FIG. 20)determines when the bottle is released during rotation of the roller. Ifthe length is too long, the bottle will not release from the roller, andif too short, multiple bottle drops may result. A preferredcircumferential length will cause the leading edge of the roller sidewall 620 to slice the next bottle 604B in the stack enough to lift thestack of bottles a height approximately equal to the material thicknessof the roller side wall.

[0071] In FIG. 21C, bottle 604A has been dispensed and the motorreleases the tension in the cable 612. The return spring 616 causes theroller to rotate in the direction shown by arrow 623 and return to itsoriginal position. At or near its original position, bottle 604B settlesinto the opening 624 and is ready for dispensing. The remaining bottles604C,D lower into position above bottle 604B. Various roller dispenserconfigurations can be realized. For example, the standard spring 616illustrated in FIG. 20 can be replaced by a coil spring, allowing for alower profile, and therefore, denser packing of columns. The spring 616can be replaced by a dual drive cable 612 design, a first cable torotate the roller clockwise, and a second cable to rotate the rollercounter-clockwise.

[0072] In a cable-less design as shown in FIG. 22, the motor 608 isattached directly to the hub 628 of roller 622. The motor causes theroller 622 to rotate and dispense in a 360 degree motion and to be inposition for reload. For purposes of the present invention, thisconfiguration will be known as a direct-drive system. In this system,the motor may comprise a step motor preferably geared to match theweight and load of the column of bottles above the roller.Alternatively, a more powerful motor may be used to handle the highestconceivable bottle column weight.

[0073]FIG. 23 is a perspective view of a step column, which allows forcolumns of larger height. An entirely vertical column is limited by theconstruction of the bottle as the bottle positioned at the bottom of thecolumn must bear the weight of all bottles above it. For example, atypical pharmaceutical bottle will begin to deform under the weight of25 bottles. By introducing a step 630 in the column as shown in FIG. 23,the vertical load 633A of the bottles above the step 631 is redirected633B into the side wall of the column as shown in inset FIG. 23A.Alternatively, a door 632 may be implemented in the column as shown inFIG. 23 for supporting the weight of the bottles above the door 632. Inthis configuration, the door may open and close each time a bottle isdispensed.

[0074]FIG. 24 is a closeup view of the interface between the drive cable612 and an alternative embodiment of the face of the roller 626. In thisembodiment, a fitting 640 on the end of the cable 612 interfaces with amating hole 641 on the roller face 626. A cable housing 613 protects thecable from interference along the length of the column. The cablehousing 613 is fixed in place by a cable housing mount 634 mountedagainst the side wall of the column. The return spring 616 attaches tothe roller face 626 at a pin stud 638. The opposite end of the spring isattached to the side wall of the column (not shown). Note that in thisembodiment, the cable 612 and the spring 616 interface with the face ofthe roller 626 rather than the side of the roller 618 as shown inprevious embodiments. Many embodiments are conceivable along theselines.

[0075]FIG. 25 is a perspective illustration of a rack 642 of columns603. Each column 603 includes a corresponding roller assembly 622, whichis individually addressable by the controller to dispense a bottle 604Aas shown. After dispensing, a pusher 644 pushes the dispensed bottleforward into an off-center tilt tray 646 and returns to its originalposition. The tilt tray 646 rotates in the direction shown by arrow 648for removal of the dispensed bottle by the operator. Either a returnspring or gravity returns the tilt tray 646 to its closed position. Notethat the tilt tray 646 when opened by the operator prevents entry of theoperator's hand or other objects into the rack area 642 to avoidpilferage.

[0076] To load the columns 603, each rack 642 of columns slides out inthe direction shown by arrow 650. Each rack preferably includes a keylock at the top with a keying mechanism which retains the key until therack is returned to its position, preventing loss of the key. After thecolumns are filled, the rack is returned to its normal position and thekey is removed.

[0077] FIGS. 26 is a perspective illustration of an alternativeembodiment of the present invention. In this embodiment, drawers 646 ofhelix dispensers 648 are contained in a cabinet 650. The helixdispensers 648, when activated, rotate in a single direction 652 asshown in FIG. 27. As the helix 648 rotates, any pharmaceutical packagesdisposed on the helix are pushed forward toward the front of the cabinet650. One full rotation of the helix 648 will cause the outermost package654 to be released as shown in FIG. 28, causing the package 654 to fallinto the bin 656. After the package 654 drops into the bin 656, anoperator slides open the bin 656 and removes the package. While the binis open, a door (not shown) blocks the opening between the bin 656 andthe dispensing area to prevent pilferage. The helix-dispensing unitdescribed above is particularly suitable for packages of variousnon-standard sizes, for example boxes, bags, and kits. Larger-sizedhelixes 648 may be used for larger packages and smaller helixes may beused for smaller packages. The helixes 648 are each individually drivenby a stepper motor located in the rear of each tray.

[0078]FIG. 29 is a remote control dispenser embodiment well-suited foruse in a doctor's office or in a small clinic. The top unit 660 includesa column dispenser as shown in FIG. 25. The bottom unit 662 includes ahelix dispenser as shown in FIGS. 26-28. This combination of dispenserscovers a range of package styles for controlled substances, tool kits,and bandages for a typical clinic.

[0079]FIG. 30 is a perspective illustration of a cabinet-styledispensing system. A closet 664 encloses a plurality of cabinets 668.Each cabinet contains several racks 670, having a plurality of columns672 (See FIG. 31). The racks may be positioned in the top 670A or bottom670B of the cabinet 668. The top 670A and bottom 670B racks may feedinto a single door as shown or multiple doors. This embodiment isparticularly well suited for pharmaceutical warehousing or for operationin the pharmacy of a large hospital. Such a system is capable of storingand organizing thousands of different pharmaceuticals, eachpharmaceutical being automatically trackable by the software describedherein.

[0080]FIG. 31 is a perspective illustration of a typical cabinet 668used in the system of FIG. 30. Each cabinet 668 includes a plurality ofracks 670 (one rack is shown), each rack having a plurality of columns672. Each column includes a dispensing unit, for example, a roller 622which is individually addressable. The bottles are dispensed onto agravity-fed track 674 or onto a conveyor belt which conveys thedispensed bottle to an opening 676 for handling by the operator.

[0081]FIG. 32 is an illustration of an alternative dispensing unit. Theunit includes a plurality of workstations 678, each workstation having acorresponding dispensing port 680. The unit further includes a cabinet682 for storing a variety of pharmaceuticals and a conveyer means 684for conveying a dispensed pharmaceutical from the cabinet area 682 andfor distributing it to the appropriate dispensing port 680. Eachworkstation 678 also includes a printer for printing labels andinstructions as described herein and a bar code reader for verifyingthat proper dispensing has occurred.

[0082] The workstation can alternatively be configured with integratedvoice response software and hardware to permit external initiation of arefill order. In such a configuration, a patient telephones theworkstation, enters a secret code and initiates refill dispensing. Afterdispensing as occurred, the workstation verifies such to the patientindicates a time for pick up. At the next opportunity, the operator ofthe workstation prepares the bottle label and instructions, and verifiesthat proper dispensing has occurred.

[0083] In a kiosk configuration as shown in FIG. 33, a cabinet 686encloses a carousel-type rotatable cabinet 688 containing a plurality ofindividually addressable locations 690. Upon receiving a dispensingsignal, the carousel 688 rotates to align the correct column 690 withthe dispenser 692. The dispenser 692 includes a grabber 694 whichremoves the bottle from its storage location 696. The grabber 694conveys the pharmaceutical downward to dispensing drawer 698 and rotatesto place the pharmaceutical in the drawer 698. The operator removes thepharmaceutical from the drawer and completes the dispensing process.

[0084] FIGS. 7A-7C are flow diagrams of the computer 46 software. Thesoftware is preferably in a user-friendly windows format. In a standardformat, the software is accessed on the host computer. Alternatively,the software is accessible by a remote terminal 151 or a pen-basedpersonal data assistant 152 through a remote access gate 153. A splashscreen 154 containing the company name, for example is output on thescreen and the user is queued for a password 155. If the password isentered correctly, a main menu 156 is generated requesting the user to:access a prescription 156A; print a report or label 156B; investigatethe database 156C; communicate with a remote location 156D; service thedatabase 156E; maintain the cabinet 156F; load additional software 156G;and exit 156H. If exit 156H is selected, the program ends 157.

[0085]FIGS. 7B and 7C are flow diagrams of the prescription submenu 160.The computer queues the user as to whether he would like to enter a newprescription 161, refill an existing prescription 162, or return to themain menu 163. If the user selects the new prescription 161 option, heis queued for a password 164. The user is next asked to enter thepatient name 165. If the name is not known, then a search program 166can search for the patient name or download the patient name from amainframe 167. When the patient name is known, the user enters variousprescription information and confirms that the data entered is correct169. Next, the software runs a clinical review 170 and determineswhether the prescription is proper 171.

[0086] If the prescription is proper, a bottle is dispensed 172 and thebar code of the dispensed bottle is scanned 173. If the bar code doesnot match that which was expected 174, then a warning is displayed 175,a communication link is set up with headquarters 176 and headquarters iswarned 177 of the incorrect dispensing. If the proper medication wasdispensed 174, then the computer prints a bottle label 178, generates aclinical review report 179 and conducts OBRA patient educationmonographs 180. The bottle is then administered to the patient 181 andthe computer checks inventory 182 and if inventory is low, the computercommunicates with headquarters 183 and orders new inventory 184. Thecomputer then returns to the main menu 156.

[0087] If the user selected the “refill prescription” option 162 at theprescription submenu 160, then the password is checked 185 and thecurrent patient record is displayed 186. The practitioner confirms thedata 169 and dispensing takes place in the manner described above.

[0088]FIG. 2 is a block diagram of an automated drug distribution systemfor maintaining the inventory of the RCD sites 108 in accordance withthe present invention. The various RCD sites 108 are stocked withprepackaged pharmaceuticals obtained on a just-in-time (JIT) inventorybasis from an FDA-approved drug repackager 102. The repackager 102obtains unit-dose pharmaceuticals from various manufacturers 104, andrepackages the unit-doses into a package containing multiple,prescription-sized doses. The packages must be suitable for use in theremote control dispenser units 108. The drugs are then distributed 112to municipal service centers 106 which operate as regional distributionfacilities in major urban areas. In turn, each municipal service center106 redistributes 114 the packaged pharmaceuticals to each remotecontrol dispenser 108 in its region.

[0089] The entire system is linked by a communication network 116, 118,120. The inventory status of each remote control dispenser 120 iscommunicated to the corresponding municipal service center through astandard telephone link 120. Restocking requests and other inventoryinformation are communicated 118 from the municipal service center 106to headquarters 100 or any desired combination thereof. Headquarters 100communicates 116 inventory requirements to the repackager 102. Inresponse, the repackager 102 fills the order and ships the stock to theappropriate municipal service center 106. In this manner, headquarters100 maintains an automated and continually-updated inventory of allremote control dispensers 108 on a JIT basis.

[0090] The system is further capable of monitoring patient records andbillings and can format electronic third party billings for processingby the health care provider. With expanded software, patient records canbe accessed on an integrated basis allowing for monitoring of drugside-effects and compliance.

[0091] In a preferred distribution system, a computer at the distributorheadquarters 100 sends a restocking request via communication link 116to the FDA-approved repackager 102. The repackager 102 fills the orderand sends it by overnight air courier to the designated municipalservice center 106. At the municipal service center, the drugs aredistributed to drivers for specific remote control dispensers 108 in thelocal community. A driver delivers the drugs and restocks the remotecontrol dispenser 108. As drugs are dispensed from the remote controldispenser 108, the inventory, sales, and restocking requirements areupdated and transmitted via telephone link 120 to the computer at themunicipal service center 106. The municipal service center computer islinked 118 to a similar computer at the distributor headquarters 100,completing the communication loop.

[0092] Pharmaceuticals are preferably bar-coded at the repackager 102.The pharmaceuticals are tracked using bar code information through eachstep of the process to the point of sale at the customer. In this way,all transactions are recorded and communicated in real-time toheadquarters 100. This integrates accounting, accounts receivable, andinventory management systems, which allows the distributor headquartersto operate with minimal staffing. Each step of the process isself-contained and modular allowing rapid and flexible geographicexpansion.

[0093] Each remote control dispenser is preferably placed on aninventory replenishment schedule. The number of weekly supply visits isa function of the rate of inventory usage. A computer record ismaintained of prescriptions dispensed and product remaining. If there isa sudden increase in inventory activity, for example if a particularvariety of medication is running low, an emergency call is initiated bythe remote control dispenser 108 to the municipal service center 106indicating the need for rapid inventory replenishment. The inventorypreferably consists of the most frequently prescribed products used byphysicians utilizing the unit. The variety can be adjusted at any timeand will vary from location to location.

[0094] A software module can be added to optimize use of the drugdispensing system for the administration of a clinical trial. As shownschematically in FIG. 8, clinical trials under current FDA regulationscan be conducted in three phases; Phase I at 194 is to access toxicity;Phase II at 196 is to assess safety; Phase III at 197 is to assessefficacy, and possible Phase IV studies 198 for limited distribution. Itis highly desirable to automate these procedures as the prompt andaccurate evaluation of new treatments for safety and efficacy can leadto expedited regulatory review and approval.

[0095] The software is formatted to provide for administration of thesethree phases including the administration of the drug and a placebo in aso-called “double blind” procedure and to print out reports suitable forsubmission to the regulatory authority which include detailed data ondistribution and dose. The computer records which packages containplacebos and which patients receive them. The computer 100 can recordand execute various functions 195 in connection with these studiesincluding printing of reports at printer 56, or communications alongtelephone line 192 for void activated or voice prompted follow up withthe patient 190. These can include contacting the physician to reportside effects or other information. A monogram on drug compliance isprovided to each patient including drug interaction, side effects ordietary instructions.

[0096]FIG. 9 is a schematic block diagram of an RCD controller inaccordance with the present invention. The host computer 46 is coupledto the RCD controller 42 via a standard serial interface, for example,an RS-232 interface. A port P1 receives the serial signal 214 anddistributes it to a bidirectional tristate buffer 200. The bufferedsignal 216 enters a microprocessor 204 where it is decoded.

[0097] The microprocessor 240 decodes the serial signal 216 andactivates an individual power blank line 218 and an individual solenoidline 222. The solenoids 212 are partitioned into n power banks 208, onepower bank for each rack 24 in the cabinet. Each power bank 208 isactivated by a data bus 218 output from the microprocessor 204. Thepower bank lines 220 are distributed to an array of solenoid selectors210. The solenoid selectors combine the power bank signals 220 andsolenoid signals 222 into an addressable array. If a power bank signal220 is enabled, then power to the corresponding rack is activated. Thesolenoid signal 222 enables a particular solenoid 212 in the activatedrack for dispensing. The solenoid signal bus 222 is m bits wide forselecting one of the m solenoids in the rack 24.

[0098] As stated above, the RCD cabinets can be daisy-chained so that aplurality of cabinets 20 are controlled by the same host computer 46. Asecond port P2 on the controller board 42 passes the serial signal 214to the next board in the chain 224. A station-select switch 202 providesadditional decoding so the controller 42 has knowledge of its address inthe chain.

[0099] Another preferred embodiment of the invention is illustrated inconnection with FIG. 10 where a dispensing cabinet 20 is positioned on acart 248 having wheels and operable as a stand alone unit. The cart 248can be used to support the unit relative to a wall surface inconjunction with bolts 250 or other suitable housing support mechanism.The housing support elements 250 can be used to support the cabinets 20relative to the supporting surface without any other means for support.

[0100] Each cabinet 20 can also be insulated and provided with a coolingsystem 244 and/or a heating system 246. As illustrated, the coolingsystem 244 can be contained within the housing 20 on the frame of doorpanel 240. The heating systems can be used in the same panel 240 or inthe adjoining panel 242. This system provides for the heating and/orcooling of selected drugs that require temperature regulation forstorage. Many antibiotics, for example, must be maintained at atemperature of between 40-50 F. to remain viable. One or moretemperature sensors 252 can be positioned in the housing to monitortemperatures which can be regulated by controller and be recorded incomputer 100 memory.

[0101] The remote pharmacist concept is an extension of the remotecontrol dispensing capabilities of the present invention. A computerworkstation is provided to assist a technician or other registeredpharmacist in the filling of prescriptions. In general, this comprisesseveral steps which are listed below:

[0102] 1) retrieve the patient inquiry data-this defines the patient forwhom the prescription is intended; the allergy, drug, and disease statesof the patient; and the insurance payor(s) of the patient;

[0103] 2) select the drug, signa, and other prescription-relatedparameters such as “refills authorized”, “dispense as written”,“compound code”, etc.;

[0104] 3) select the prescriber identification number;

[0105] 4) verify information in steps 1, 2, and 3 against theprescription;

[0106] 5) perform drug utilization review (DUR);

[0107] 6) submit claim to payor;

[0108] 7) dispense and verify drug package;

[0109] 8) print and attach patient label to drug package;

[0110] 9) verify correct label attached to drug package;

[0111] 10) provide patient with label drug package and associateddocumentation such as receipt, patient counseling text, refillinstructions, etc.;

[0112] 11) provide patient with oral counseling when required orappropriate.

[0113] In traditional practice, a registered pharmacist physicallylocated at the dispensing site performs all of the above steps. In somecontemporary situations, a pharmacy technician may perform steps 1, 2,3, 6, and 7, and the registered pharmacist will perform steps 4, 5, 8,9, 10, and 11. In this situation, both the pharmacy technician and theregistered pharmacist are located at the dispensing site, where oneregistered pharmacist may serve several pharmacy technicians.

[0114] In some states it is required by law that a registered pharmacistperforms steps 4, 5, 9, and 11. In these states, the registeredpharmacist provides cognitive or consultative service and leaves themechanical tasks associated with filling and dispensing the drug to thepharmacy technician. This allows the registered pharmacist to enhancehis contribution to the medical care process by affording the pharmacistwith more time to focus on those steps which best utilize thepharmacists training and expertise. The remote pharmacist (RRPH) conceptof the present invention enables a registered pharmacist to provide theabove-cognitive/consultative services without being physically locatedat the dispensing site. This is accomplished through use of moderntelecommunications technology in conjunction with a computer-basedpharmacy workstation. In this manner, the expertise of a registeredpharmacist operating an R.H. can be shared among a large number ofpharmacy technicians, increasing the level of medical care provided in acost-effective manner.

[0115] The R.H. apparatus and method of the present invention iseffective in several configurations. A first configuration is shown inthe block diagram of FIG. 11A wherein an R.H. 260 services severaldistinct RCD locations 262A-D. Each RCD 262A-D is at a distinct physicallocation and is connected to an R.H. workstation 260 via atelecommunications link 261A-D, for example, a computer modem. Thisconfiguration is appropriate, for example, for servicing severallow-volume clinics or emergency rooms where it is not economical toplace a pharmacist. The mechanical tasks associated with dispensing thedrug can be handled by an RCD pharmacy technician or by a qualifiedmember of the medical or administrative staff. A pharmacist based at theR.H. provides the pharmacy expertise needed for an effective dispensingprocess.

[0116] The configuration of FIG. 11B is applicable in a large volumeclinic where several pharmacy technicians operating several remotecontrol dispensers (RCD) units 265A-265D perform the mechanical tasks ofsteps 1-3 and 7-10 outlined above and a pharmacist operating an R.H.workstation 264 performs the cognitive or consultative steps 4-6. Inthis configuration, the R.H. workstation 264 can be, but need not be,located in the same facility as the RCD units 265A-265D. If they are inthe same facility, the R.H. workstation 264 can be linked to the RCDunits 265A-D and an RCD cabinet 266 via a local area network (LAN) 268.In this configuration, a patient presents a prescription to a technicianat one of the available RCD terminals 265A-265D. At this terminal, apharmacy technician performs steps 1-3. The results are transmitted overthe network to the R.H. workstation, and the pharmacist at the R.H.performs steps 4-6. After the pharmacist approves the transaction, thetechnician at the RCD unit performs steps 7-10. In high-volumesituations, dispensing is performed at separate RCD cabinets 266 adaptedfor dispensing large quantities of pharmaceuticals. A label is printedat a printer 267 and attached to a pharmaceutical package, for example,a bottle. The bar code reader compares the bar codes of the bottle andlabel to ensure that the proper prescription has been dispensed. If so,the patient is presented the bottle and corresponding documentation.

[0117]FIG. 12 is a flow diagram representing the processes performed bythe pharmacy technician at an RCD and a registered pharmacist at theR.H. in accordance with the present invention. Initially, a patientpresents a prescription to a technician at an RCD unit 270. Thetechnician determines whether the drug is stocked in the RCD unit 271.If the pharmaceutical is not stocked, then the technician decideswhether to electronically transfer via facsimile, email, or otherwise,the prescription to an affiliate 272. If the prescription is transferredto the affiliated pharmacy, 273, the patient may travel to that pharmacyto receive the pharmaceutical. Otherwise, the prescription is returnedto the patient 274 to be filled at another RCD unit or by anotherpharmacist of the patient's choosing.

[0118] If the drug is stocked at the RCD unit, then patient data isretrieved 275, the drug is selected 276, the prescription signa isselected 277 and additional scripts may be entered 278. Following this,the identification number of the prescriber is entered 279 and all datais transmitted to the R.H. workstation 280. At the R.H. workstation, thepharmacist verifies the prescription 281 and performs a drug utilizationreview 282. If issues arise during the review, the pharmacist isimmediately made aware of the conflict and given an opportunity toreview and, if appropriate, override 283 the interventions 284. If thepharmacist decides at this point to discontinue the dispensing 285, theprocess is aborted 294. If the pharmacist decides to continue thedispensing anyway 284 or there were no interventions 283 in the firstplace, then claim adjudication is performed 286. During adjudication286, a patient's insurance information is automatically verified todetermine whether the insurer will pay for the prescription, and if so,if any co-payment is required from the patient. If a negative responseis received 287, drug dispensing is aborted 291. Otherwise, the drug isdispensed and verified with a bar code reader 288. If an improper drugwas dispensed, the technician is notified to abort the process as asystem failure has occurred 292. Upon system failure electronicnotification is performed. Distribution headquarters or a regionaldispensing location or agent can be notified by the RCD system of anincorrect dispense is shown. Electronic notification can take the formof a fax, email, file transfer, pager notification, or any otherelectronic transfer protocol. If verification is positive, a label isprinted and affixed to the bottle 290, and the prescription is dispensedto the patient by the technician 293.

[0119] FIGS. 13A-13Q are flow diagrams representing the softwareoperating on the remote pharmacist (RRPH) workstation 314. The system isaccessible in a variety of configurations and on a variety of platformsincluding a pen computer 301, a laptop computer 302, and a workstation314 accessing the system either at an on-site location or through atelephone network 305. The pharmacist can also access the system viatelephone modem 305 from a remote location 304 anywhere in the world.The operating system is preferably a windows-based system, for example,OS/2™, Windows 95™, or Windows NT™. A programming language, for example,OS Visual Basic™, Borland Delphi™ and various tool kits such as OCX-VBXLibrary Kits and ButtonMaker™ by FarPoint Technologies™ provide theframework for supporting the Windows environment. The windowsenvironment is preferably mouse-driven and may optionally employvoice-activated technology touch screen, or wireless hand-held terminalsthat remotely control the RRPH, such as a Zenith Data SystemsCruisepad™, for ease of use.

[0120] Upon entering the operating system 303, the program starts 306 ata main menu 307. The main menu 307 is referred to as a jump screen shownin FIG. 14A. At the jump screen 500, the operator can select fromseveral options including: entering a new prescription 308, refilling aprescription 310, entering new patient information 311, generatingreports 312, performing maintenance functions 315, or exiting the system313. Each selection requires the operator to enter a password 309A-309E.The password function 309A-309E provides an appropriate level ofsecurity for each task. For example, generating a new prescription 308may require a high level of security, for example, the pharmacist, whilegenerating a report 312, may require a lower level of security, forexample, a technician.

[0121] The password gate task 309 is shown in FIG. 13B. Initially, theuser is prompted to enter a user ID and password 318 which is checkedagainst a database 319 of user IDs, passwords, and security levels. Thescreen for entering the username and password is shown in FIG. 14Q. Ifthe user ID and password are verified 320, then the operator ispermitted to proceed and the system is returned 322 to the operationwhere the password task was initially called. Otherwise, a login attemptis recorded 321 and the user is prompted again to enter his password318. Security measures may be installed to prevent break-ins. Forexample, when a predetermined number of invalid login attempts 321 arerecorded, the system may be disabled for a period of time.

[0122] Returning to FIG. 13A, if the option to enter a new prescription308 is selected and a proper password is entered 309A, then the operatoris presented with a menu of selections shown in FIG. 14B. The menu isgenerated using a tab metaphor representing a plurality of files for theuser to “thumb” through using the mouse. The tab selections includepatient information 323A, payment 323B, drug 323C, signa 323D, patientmedical profile 323E, and data verification 323F. In the patient window323A shown in FIG. 14B, the operator is prompted to enter fundamentaldata concerning the patient including name, address, phone numbers, age,sex, weight, identification numbers, basic health information, andemployer information. Alternatively, the operator may use the drop-downbox 529 to select the patent name from a list. In which case therelevant data will automatically appear in the data windows.

[0123] Upon entering the above data, the operator next selects the payorand prescriber window 323B shown in FIG. 14C. In this window, theoperator is prompted to enter information about the prescribingphysician 501, the responsible pharmacist 502, and the person orinsurance company responsible for payment 503. Pull-down menus indicatedby arrows 504A, 504B are provided to allow the operator to select from aplurality of prescribers and pharmacists previously entered into thedatabase. Upon selecting a prescribing physician from the pop-down menu504A, the relevant data 501 will automatically appear in the datawindows. This patient data can be required before an enabling commandcan be sent to the controller and/or printer to dispense the desireditem or print the necessary labeling an/or patient instruction printout.

[0124] In the drug window 323C, shown in FIG. 14D, the operator isprompted to select from a pop-down menu 505 of drugs available in theRCD units. When a drug is selected, the generic name, brand name, andNDC number of the drug available in the RCD unit automatically appearsin the window, along with the quantity of doses in each bottle. At thistime, the operator is afforded an opportunity to select a genericsubstitution 506, as opposed to a brand name drug. A genericsubstitution generally saves money for the patient and tends to be amore current formula for the drug. Label data to be printed upondispensing is automatically updated by the software to include thegeneric drug information. In addition, the software automaticallymaintains an inventory and keeps track of the drugs which have beendispensed and assures a first-in-first-out inventory process. Thisprovides a round-robin dispensing system so that drugs are continuallycirculated and therefore, expiration dates will pass less frequently. Inaddition, this system averages out solenoid use for each column in thecabinet such that one column does not wear more quickly than othercolumns in the cabinet. The drug window 323C also requires the operatorto select an ICD-9 disease code from a pop-down menu 507. The ICD-9 codeis an industry standard code number for a variety of ailments known tophysicians.

[0125] Returning to FIG. 13C, upon entering the required data in thepatient 323A, payor and prescriber 232B and drug 323C windows, theoperator selects the signa window 323D. In the signa selection taskshown in FIG. 13D, corresponding to window FIG. 14E, the operator isprompted to enter a signa by code 328, by text look up, or manually 330.Signa codes are industry standard acronyms or codes used by pharmacistsfor providing instructions to the patient. If the operator enters a code328, then the software determines whether the code is in the database331 and whether it has been used before 332 in the system. If not, thecomputer is instructed to learn the new code 333 by adding it to thedatabase 334. In addition, the computer questions whether the signadosage amount is correct for the new signa, as shown in FIG. 14S. Thenewly learned code is then available to the non-technical user via theSigna by Text option 329. In this way, the commonly-used Signacombinations of a facility (i.e. regimen) are learned and more readilyavailable. The properties of the signa code include 335 include thenumber of units per day, the day's supply, the daily dosage, and therefill date. These properties automatically determined by the softwareafter the operator enters the signacode. Following this, the softwarereturns to the point where the signa selection was called (see FIG.13C).

[0126] In the profile window 323E shown in FIG. 14F, a menu of sub-filesare available to the operator for selecting various patient medical dataincluding refill information 508, allergy information 509, diseaseinformation 510, and medication history 511. In the allergy window 509shown in FIG. 14F, a patient allergy table 512 includes a list of knownallergies for the patient. The patient allergies 512 are selected from amaster allergy table 513 which includes all known pharmaceuticalallergies. The operator scrolls through the master allergy list andselects the appropriate allergy. Using the drag-and-drop method, theallergy is copied from the master allergy table to the patient allergytable 512. The allergy information is used during the drug utilizationreview (DUR) to determine if there is a conflict between the patient'sallergy history and the prescribed pharmaceutical or any pharmaceuticalin the patent profile. In FIG. 14G, the patient's disease history istracked in a similar manner. A disease history for the patient 515, isselected from a master disease table 514. In FIG. 14H, a medicationhistory for the patient is tracked. The data tracked includes activemedications 516 and inactive medications 517, including the date thatthe medication was dispensed, the brand name, and source of thepharmaceutical. Again, the tracked medications 516, 517 are selectedfrom a master medication window 518. The data includes the National DrugCode (NDC) for all prescriptions.

[0127] In the verify window 323F shown in FIG. 14K, the operator isgiven an opportunity to view all relevant prescription data. The dataincludes a synopsis of the patient information, payor, prescriber,ICD-9, drug, signa, and adjudication information. At this point 325 (seeFIG. 13C), the software verifies that all relevant data has beencaptured. If it has not, the operator is prompted to enter thoseportions of the data which are missing. Upon verification, the continuebutton 519 is enabled. This is indicated by darkening of the letterswhich spell out the word “continue” and by the button 519 flashing whenready. If any information is missing, the computer directs the operatorto the appropriate window for entering the missing information.

[0128] When the continue button 519 (see FIG. 14K) is selected by theuser 327 (DUR), the software performs a drug utilization review 337 asshown in FIG. 13E. During a drug utilization review, the softwareanalyzes the patient profile 336 compiled by the operator and performs aplurality of tests 337 to check for drug conflicts. The tests include:drug allergy, drug disease, drug interaction, dose check, duplicatetherapy, drug food, pediatrics, geriatrics, pregnancy, lactation,disease additive, drug additive, drug induced, polypharmacy, sideeffects, and other standard DUR tests. Note that this process need notbe sequential as shown in FIG. 14K. Threads may be used to obtainsimultaneous occurrences of each test. In this manner, the patientprofile can be simultaneously tested in the DUR to arrive at resultsfaster.

[0129] With reference to FIG. 13F, after a DUR test is completed, theuser is provided with a drug utilization review window, as shown in FIG.14I including a menu of tabs representing the various tests conducted.The DUR results are displayed as a series of tabbed folders of variouscolors as shown in FIG. 14I. Red folders 523, for example the“Lactation” folder of FIG. 14I, indicates a conflict with requires anoverride by the pharmacist. A red drug interaction field or has anadditional feature of displaying a Drug Information Facts monograph forthe user as shown in FIG. 14O. The user can additionally print themonograph for consultation with the responsible dispenser. In thismanner on-line Drug Information is available for each drug interaction.A yellow folder 522, for example the “Duplicate Therapy” and “DrugAdditive” folder, indicates that the tests should be checked by thepharmacist but does not require an override. A green folder, for examplethe “Geriatrics” folder 521, indicates that the tests passed without aconflict.

[0130] Returning to FIG. 13F, if the operator has selected a folderwhich is tabbed red, then the override button 520 is enabled 342 toallow the operator to override the flagged conflict. If no red tabs 339are generated by the test, then the continue button 519 is enabled 340.When the continue button is selected 343 by the operator, the operatoris prompted to enter a payment method 346. The payment method isselected in payor window 503 of FIG. 14C to determine which path tofollow. If cash is selected, then a dispense subroutine is issued 377.If a third party payor is selected, then adjudication or paymentconfirmation takes place 347. The dispense and adjudication processeswill be described below.

[0131] When the override command is selected 344, an override task 345is called as shown in FIG. 13G. If the user is not authorized 349 tooverride the conflict, then a warning is displayed 358 and a remote orlocal pharmacist 359 is consulted. If a remote pharmacist is selected,the remote pharmacists key 361 is displayed and a connection isestablished 364 with encrypted data during the data exchange 367. Next,the computer performs an out dial to the remote pharmacist 368 who isgiven control of the dispensing process. As shown in FIG. 14V, during anoverride, the remote pharmacist will be required to enter a comment fordispensing to proceed.

[0132] If a local pharmacist is selected 359, the authorized pharmacistis prompted for a password 360. If several invalid attempts are recorded363, then the override is ended and the dispensing will not be allowedto take place. If the pharmacist password is authorized 362, or if theuser is authorized 349, an override window shown in FIG. 14L ispresented to the operator. The override window identifies the operatorand the conflict to be overridden 350. The user is prompted to enter ajustification for the override and will not be allowed to leave thisoverride screen without entering a comment in the comment window 525.After the appropriate data is entered, the data is captured to thedatabase 355 by the operator clicking on the save button 526 and theprogram returns to the drug utilization review window shown in FIG. 14I.At this point, the previously red folder 523 will be given a new color,for example grey, to indicate that the conflict has been overridden.

[0133] During an adjudication process shown in FIG. 13H, a data packetis initially prepared 369 and the modem is initialized 370 as shown inFIG. 14P. After initial handshaking 371, a determination is made whethertransmission 372 is enabled. If transmission is not yet cleared, thenthe software waits for a predetermined period of time 373, and if a timeout occurs 374, then the transaction is saved to disk for later use 376so that the data does not have to be reentered and the pharmaceutical isdispensed 377. If transmission has been cleared 372, then data istransmitted 375 and the process waits for a response 378. If after apredetermined period of time 379, the software determines that it haswaited too long 380, then the transaction is saved to the disk for lateruse 381 and the pharmaceutical is dispensed.

[0134] When a response is received 378, the returned data packet isparsed 383 as shown in FIG. 13I. If the payor has not authorized thetransaction 384, then a rejection is displayed on the monitor 393 andthe operator is queried to cancel 388, save the transaction for later389, or resend the transaction 390 as shown in FIG. 14V. If cancel 388is chosen, then the program ends and returns to the jump screen 500shown in FIG. 14A. If “save for later” 389 is selected, then thetransaction is saved to the disk for later use 392 and a dispensecommand is ordered 377. If resend 390 is selected, then the operator isgiven an opportunity to modify the outbound data packet 391 andadjudication is initiated again. If the payor authorizes the transaction384, then an approval is displayed on the monitor 385 and the operatoris queried whether he accepts the approval 386. If so, and the operatorhas to respond to a payor DUR 387, then adjudication is performed again.Otherwise, a dispense task 377 is performed.

[0135] With reference to FIG. 13J, in a dispense task 377 thetransaction is initially recorded in a transaction database 394 and adrop signal is sent to the dispenser 395. Upon receiving feedback fromthe dispenser 396, two barcoding safety options are possible 397. Underthe first option, the barcode on the dispensed bottle is scanned 404after a prompt by the software as shown in FIG. 14M. The prompt 528requests the operator to scan the barcode label. After scanning, if thebarcode matches that which the computer expects 405, then a patientmonograph and bottle label is generated as shown in FIG. 15. Thecomputer next prompts the user to report that the label has been appliedto the bottle as shown in FIG. 14R.

[0136] The barcode applied to the dispensed package by the repackagermay contain expiration date information which the computer automaticallychecks upon scanning the barcode. If the package has expired, theoperator may be warned, and the label and monograph print functiondisabled. Also, the computer may check the package date against theending date of the prescription period and disable the print function orotherwise warn the operator if this test fails.

[0137] Alternatively, if the second barcoding safety option is selected397, then the printout is generated initially 398 and labels and safetybarcodes from the printout are adhered to the bottle 399. The repackagerbarcode on the bottle and a prescription generated barcode are opticallyread or scanned 400 and the computer electronically compares the twocodes to determine if they match 401.

[0138] Returning to FIG. 13J, if the bar codes fail to match 402, 403,then all data responsible for generating the error is captured 417 asshown in FIG. 13L and a warning is issued to the operator that thepharmaceutical or other item is not cleared for dispensing 418.Potential corrective measures are displayed 419, and the operator isgiven the option to lock the column generating the error 420. If so, theoperator instructs the computer to lock the column 421. The server isautomatically notified 422 by the computer via modem 423. After theserver acknowledges receipt of the error 424, the program returns to thepoint where the dispense task was called.

[0139] With reference to FIG. 13K, if a proper dispensing has occurred,then the transaction is recorded to the data base 407, and the computerdetermines whether inventory is at or below a predetermined restockvalue 408. If the inventory is at an appropriate value, the programreturns to where the dispense task was called. Otherwise, an encryptionprogram is activated 409 and an outdial to the server headquarters isperformed 410 via modem 411. If the server acknowledges 412, then thefiles are marked as sent 413 and the software returns to the point wherethe dispense task was called. If the server fails to acknowledge withina limited number of attempts 414, then the operator is warned 415 that acommunication problem exists and a command to start a timer for periodiclow-inventory-dial-outs or “LIDOS” is initiated 416. A LIDO is aparallel background process for calling the distribution headquarter toreplenish inventory. Following this, the computer returns to the pointwhere the dispense task was called. In addition to the automatedinventory processes described above, an operator may at any time monitorinventory in an RCD unit by selecting the “inventory” option shown inFIG. 14T. This image shows the number of bottles in each RCD bin orcolumn.

[0140] During an override procedure shown in FIG. 13G, if a connectionto a remote pharmacist 364 is established, at the remote pharmacistworkstation as shown in FIG. 13M, the data received is decrypted 428,and the computer determines whether a share or package exchange 427 isoccurring. In the case of a share exchange, the remote pharmacistassumes control of the system 429 and a remote pharmacist password isgenerated 426. In the case of a packet exchange 427, the data isdisplayed 425, and the remote pharmacist password is generated 426.

[0141]FIG. 13N is a flow diagram representing remote pharmacist passwordgeneration 426. Initially, a display key is transmitted from the remotesystem 431. The key is entered into the local program 432 and the localprogram decodes the key and generates a counter key 433. Thiscounter-key is used as the remote pharmacists password 434. At thispoint, the program returns to the point where the remote pharmacistpassword generation task 426 was called.

[0142] With reference to FIG. 13O, if the refill option 310 is selectedat jump screen 500 shown in FIG. 14A, then all relevant data should havealready been entered into the database. At this point, the patient'sname is selected 435 and a refill is selected for the patient 436. Aftera payment method is selected 437, a drug utilization review isperformed, along with adjudication and dispensing as described above.

[0143]FIG. 13P is a flow diagram representing tasks performed when thenew patient 311 option is selected at the jump screen. In this task, newpatient demographics 438, allergy profile 439, disease profile 440, andmedical profiles 441 are entered for the new patient. After this task isperformed, control is returned to the jump screen of FIG. 14A.

[0144] With reference to FIG. 13Q, if the reports option 312 is selectedat the jump screen, a list of available reports are presented to theoperator. The operator is given a choice to print or preview a report443. If the preview option is selected, then the report is generated onthe monitor 444. After viewing the report 444, the operator is given achoice whether to print the report 445, and if so, the report is sent tothe printer 446.

[0145]FIG. 16 is a schematic diagram representing a typical remote drugdispensing configuration in accordance with the present invention.System access locations are shown in a first city 550, second city 551,and a third city 552. Pharmacists and physicians in the second 551 andthird 552 cities communicate with physicians, pharmacists, andtechnicians in the first city 550 via telephone connections 553, forexample, a telephone modem, or an ISDN connection. A gateway computer555 in the first city 550 operates as a server to receive and transmitmessages on the telephone lines 553. Access stations in the first city550 are interconnected via an intranet 554 otherwise known as anethernet or local area network (LAN). The LAN may be located in ahospital, an HMO, or a pharmacy. Hardware connected to the LAN 554includes the gateway workstation 555, a laptop computer 566 with videoteleconferencing capabilities 567, a pen computer 568, a facsimile 557,and an RCD host computer 564 operating an RCD unit 556. The RCD hostcomputer 564 may also have video teleconferencing hardware 563 and aplurality of pen computers 565 connected thereto.

[0146] When a patient approaches a technician at an RCD unit 556, thetechnician initiates the dispensing process by entering relevant patientdata into the RCT host computer 564. If the dispensing process requiresthe expertise of a pharmacists, then the technician at the host computer564 issues a request to an available pharmacist operating the pencomputer 568, laptop computer 566, or workstation 555 within thebuilding in the first city 550, or may request the services of apharmacist operating an RPH workstation 559 in the third city 552 or apharmacist at the laptop computer 561 in the second city 551. Relevantdata is exchanged and video teleconferencing is enabled between thetechnician and the pharmacist or prescribing physician if appropriate.Hand written scripts may be transferred to and from the first city 550via facsimile 557. The facsimile image maybe downloaded into the hostcomputer 564 and stored with relevant patient data.

[0147]FIG. 17 is a schematic block diagram representing the transfer ofdata between an RCD host computer 570 and a remote RPH workstation 571.A technician at the host computer 570 receives a request for aprescription from a patient at the RCD unit 572. The technician preparesthe relevant data including the patient record, the prescription to bedispensed, and the adjudication information. The data is packed,encrypted and transmitted over the internet 573 to the RPH workstation571 operated by a registered pharmacist. The pharmacist receives thedata, conducts the relevant tests and makes a determination regardingdispensing the pharmaceutical. A packet of data is prepared with thepatient's records, data, and any comments, along with a signal to causethe RCD unit 572 to dispense. This data packet is transmitted over theinternet 573 as an Email message or other data file to the host computer570. The host computer 570 receives the message, unpacks the data, anddispenses the pharmaceutical automatically, in real time. In thismanner, a pharmacist operating a remote workstation 571 causes the RCDunit 572 to dispense the pharmaceutical in real time. Alternatively, thedispense commands may be issued in a batch process, requiring thetechnician at the host computer 570 to issue the dispense command to theRCD unit. Scripts from the host computer 570 generated by the technicianmay also be transmitted to the pharmacist at the RPH workstation 571 inbatch form.

[0148]FIG. 18 is a schematic block diagram representing connectivitybetween RCD units at various sites. For example, a hospital site 575,may communicate with an HMO 576 via the internet 579. At the hospitalsite 575, two RCD units 581A, 581B are supported by two RCD hostcomputers 580A, 580B respectively. The host computers communicate viaintranet 578A, otherwise known an internal internet, or a LAN. A server584 on the LAN 578A provides an interface between the LAN 578A and theinternet 579. The RCD units 581A, 581B may serve two separate wards inthe hospital. At the HMO office 576, a similar configuration employingtwo RCD units 582A, 582B hosted by host computers 583A, 583B areinterconnected by a LAN 578B, and server 585. Distribution headquarters577 also interfaces with the internet 579. In this manner, headquarters577 can automatically keep track of stock levels, patient data, andother data warehousing functions.

[0149]FIG. 19 is a schematic block diagram representing dual modemconfiguration. An RCD host computer 585 serving an RCD unit 593 in afirst city 586 is configured to operate with a first and second modems594A, 594B. Using the first modem 594A, the technician at the hostcomputer 585 may solicit instructions from a pharmacist in a second city587 operating a RPH workstation 589, a pen computer 590, or a laptopcomputer 591 each equipped with a modem 592A-C. A second modem 594B onthe RCD host computer 585, allows for adjudication to take place with anadjudication switch 590 in a third city 588 while the link between theRPH workstation 589 and the RCD host computer 585 is maintained. In thismanner, a pharmacist at a remote location in a second city 587 canaccess an RCD host computer 585 through a first modem 594A and performadjudication between the RCD host computer 585 and an adjudicationswitch 590 in a third city 588 using the second modem 594B.

[0150] Alternatively, if the remote pharmacist at the RPH workstation589 did not wish to remain online during adjudication, then the remotepharmacist could issue an adjudication batch command to be performed bythe RCD host computer 585. After the batch command is issued, the linkbetween the RPH workstation 589 and the host computer 585 is deactivatedand the host computer performs adjudication. After adjudication iscompleted, the RCD host computer 585 reestablishes the link between theRCD host computer 585 and the RPH workstation 589 to inform the remotepharmacist that adjudication is completed. This batch process requiresonly a single modem at the RCD host computer 585 which is time-sharedfor script and adjudication processing.

EQUIVALENTS

[0151] While this invention has been particularly shown and describedwith references to preferred embodiments thereof, it will be understoodby those skilled in the art that various changes in form and details maybe made therein without departing from the spirit and scope of theinvention as defined by the appended claims. Those skilled in the artwill recognize or be able to ascertain using no more than routineexperimentation, many equivalents to the specific embodiments of theinvention described specifically herein. Such equivalents are intendedto be encompassed in the scope of the claims.

What is claimed:
 1. A method for dispensing a packaged medical productcomprising: providing a dispensing system including a dispenser, a labelprinter and a system computer having a graphical user interface, thecomputer being connected to a second computer; loading a plurality ofdifferent medical products into the dispensing system using a codereader; providing a database of patient medical data; accessing thedatabase of patient medical data; selecting a medical product to bedispensed; dispensing a packaged medical product from the dispensingsystem; printing a label having a code; attaching the printed label tothe packaged medical product; reading the code of the dispensed packagedmedical product with a code reader; and verifying that the requestedpackaged medical product was dispensed by comparison of the code read bythe code reader to a reference code.
 2. The method of claim 1 whereinthe step of accessing the database of patient medical data comprises thestep of checking allergy information.
 3. The method of claim 1 whereinthe step of accessing the database of patient medical data comprises thestep of checking refill information.
 4. The method of claim 1, whereinthe step of accessing the database of patient medical data comprises thestep of checking disease information.
 5. The method of claim 1 whereinthe step of accessing the database of patient medical data comprises thestep of checking medication history.
 6. The method of claim 1 whereinthe step of accessing the database of patient medical data comprises thestep of checking drug interactions.
 7. The method of claim 1 wherein thestep of accessing the database of patient medical data comprises thestep of monitoring patient compliance.
 8. The method of claim 1 whereinthe step of accessing the database of patient medical data is performedusing a graphical user interface.
 9. The method of claim 1 furthercomprising the step of providing a patient education monograph.
 10. Themethod of claim 1 further comprising the step of maintaining a currentinventory of packaged medical products.
 11. The method of claim 10further comprising the step of updating the current inventory afterdispensing each packaged medical product.
 12. The method of claim 11further comprising the step of communicating the updated inventory ofpackaged medical products to another computer using a network.
 13. Themethod of claim 1 further comprising providing a graphical userinterface having a plurality of folders.
 14. The method of claim 1further comprising providing a dual valve dispenser for each bin in thehousing for dispensing packaged medical products.
 15. The method ofclaim 1 further comprising providing a graphical user interface having aplurality of windows including a main menu, a password screen, and anoperation selection screen.
 16. The method of claim 1 further comprisingproviding a wireless connection to the computer to perform a dispensingoperation.
 17. The method of claim 16 wherein the dispensing operationcomprises entering prescription information to the computer.
 18. Adispensing system for medical products comprising: a dispenser in whichmedical products are stored; a code reader; a label printer that printscoded labels; a system computer connected to the code reader, thedispenser, and a display, the system computer being programmed with asoftware program controlling dispensing operation of the dispenser andrecording the code on a dispensed packaged medical product, the computerbeing connected to a second computer with a communication link.
 19. Thesystem of claim 18 further comprising a card reader connected to thedispensing system that reads a card.
 20. The system of claim 18 furthercomprising a wireless communication device such that dispensinginformation is transmitted using a wireless network.
 21. The system ofclaim 18 wherein the computer is connected to a database of patientmedical data.
 22. The system of claim 18 wherein patient medical dataare accessed by the user through a graphical user interface.
 23. Thesystem of claim 18 wherein the computer is programmed to receive aninstruction from a network to dispense a prescription.
 24. The system ofclaim 18 wherein the computer is programmed to receive a request to filla prescription using an electronic card.
 25. The system of claim 18wherein the computer is programmed to receive a request to fill aprescription that is transmitted using a wireless network.
 26. Thesystem of claim 18 further comprising a wireless connection to acommunication device.
 27. The system of claim 26 wherein thecommunication device comprises a hand-held computer.
 28. The system ofclaim 27 wherein the hand-held computer comprises a personal digitalassistant.
 29. The system of claim 18 wherein the dispensing systemcomprises a dispenser housing, a display mounted to the dispenserhousing, a plurality of dispensing bins within the dispenser housing,each dispensing bin being loaded with a plurality of coded packagedmedical products to be dispensed with a dual valve dispenser.
 30. Thesystem of claim 18 wherein the system computer is connected to a memorythat stores patient data and drug interaction data.
 31. The system ofclaim 18 wherein the printer is mounted to the housing.
 32. The systemof claim 18 wherein the housing comprises a lockable cabinet.
 33. Thesystem of claim 18 wherein the code reader comprises a hand-held barcode reader.
 34. The system of claim 18 further comprising a dispensingport on the housing at which a user retrieves a dispensed bottle orpackage.
 35. The system of claim 18 further comprising a plurality ofscreens to be displayed including a password screen.
 36. A method fordelivering a prescription for a packaged pharmaceutical comprising:providing a dispensing system having a plurality of coded packagedmedical products, a label printer, a computer having a graphical userinterface and connected to a communications link; providing a databaseof patient medical data; receiving a patient request for a prescription,the request comprising a password; verifying the password; accessing thedatabase of patient medical data; sending authorization signals to thecomputer; generating a dispense order in response to the receivedrequest signals to dispense a packaged medical product; reading the codeof a dispensed package with a code reader; and verifying that therequested package was dispensed by comparison of the code read by thecode reader to a reference code.
 37. The method of claim 36 wherein thestep of accessing the database of patient medical data comprises thestep of checking allergy information.
 38. The method of claim 36 whereinthe step of accessing the database of patient medical data comprises thestep of checking refill information.
 39. The method of claim 36 whereinthe step of accessing the database of patient medical data comprises thestep of checking disease information.
 40. The method of claim 36 whereinthe step of accessing the database of patient medical data comprises thestep of checking medication history.
 41. The method of claim 36 whereinthe step of accessing the database of patient medical data comprises thestep of checking drug interactions.
 42. The method of claim 36 whereinthe step of accessing the database of patient medical data comprises thestep of monitoring patient compliance.
 43. The method of claim 36wherein the step of accessing the database of patient medical data isperformed using a graphical user interface.
 44. The method of claim 36further comprising the step of providing a patient education monograph.45. The method of claim 36 further comprising the step of maintaining aninventory of packaged medical products.
 46. The method of claim 45further comprising the step of updating the inventory of packagedmedical products.
 47. The method of claim 46 further comprising the stepof communicating the updated inventory of packaged medical products toanother computer.
 48. The method of claim 36 wherein a patient requestfor a refill of a prescription is received using a communications link.49. The method of claim 36 wherein the automated dispensing systemcomprises a card reader connected to the dispensing system that reads anelectronic card.
 50. The method of claim 49 wherein the patient requestfor a prescription is received by the card reader connected to thedispensing system that reads an electronic card.
 51. The method of claim36 further comprising providing a dual valve dispenser for each bin inthe housing, each bin containing a medical product.
 52. The method ofclaim 36 further comprising transporting a packaged medical productwithin the housing to an access port for retrieval by a user.
 53. Themethod of claim 36 wherein the code on each package comprises a bar codeincluding a National Drug Code.
 54. The method of claim 36 providing acontroller connected to the system computer.
 55. The method of claim 36further comprising loading packages into the housing, the packages beingscanned with a bar code reader during scanning.
 56. The method of claim36 further comprising providing a rotating dispenser.
 57. The method ofclaim 36 further comprising providing a motor that transports packagesin the housing.
 58. The method of claim 36 further comprising accessingdatabases in the second computer.
 59. The method of claim 36 furthercomprising sensing a product in the housing with a sensor.
 60. Themethod of claim 36 further comprising printing a label within thehousing.